Ep 00: Introduction

Ep 00:

Let’s Fix It! Introduction

Welcome to the Let’s Fix It series about the American health care system. I’m Dr. Chris Robertozzi, a practicing podiatrist. My practice is in Newton NJ, a poor rural community in the northwestern part of the state. Throughout my years of practice, I have seen significant changes in health care both in its delivery and its cost. What you are about to hear are my perspectives and opinions. I am not funded by any organization or individual. More can be learned about this endeavor by going to the website www.betterhealthcarereform.com. The website has the bibliography so you can read more on this subject if you so choose.

As a physician, it’s embarrassing to know that according to the Commonwealth Fund report 2022, despite having the most expensive health care system in the world, the United States ranks last overall in the quality of care provided of any high-income nation(1). We are the only high-income country that does not guarantee health care coverage and does not have universal health care. In 2021, 8.6 percent of the U.S. population of 331.9 million was uninsured(2). That is approximately 28.5 million people.

America is an altruistic country in that it helps everyone in the world when they have troubles. However, the fact that there are 28.5 million people without health care in the United States deserves America’s attention and assistance. It is estimated that 20% of the homeless are veterans. These individuals were willing to give their life for our freedom. In their time of need, we have literally and figuratively left them out in the cold. Being homeless is not just a housing issue, it’s a health care concern.

In the report, the cost of health care is compared from country to country by comparing the gross domestic product, commonly referred to as the GDP, to the amount of money spent in health care. The gross domestic product is the measure of the value of goods and services produced in a country during a specific time. The United States spends 17.8 percent of its GDP of 27.3 trillion dollars on health care(3). That amounts to 4.8 trillion dollars. The average country spends 9.7 percent of their GDP(3). Having the most expensive health care system isn’t bad if we’re providing the best quality care in the world, however, we’re providing the worst. How can we increase the quality and decrease the cost?

The following three examples highlight the poor quality of care in the United States as compared to the other high-income nations. The United States has the highest maternal death rate of 23.8 per 100,000 live births. The average for Organisation for Economic Co-operation and Development, referred to as the OECD, is 9.8. The United States is 2.4 times higher than OECD(3).

The infant death rate in the U.S. is 5.4 per 1,000 live births. The average OECD is 4.1 per 1,000. Then there is Norway with the lowest infant death rate of 1.6 deaths per 1,000 live births(3).

The U.S. life expectancy at birth is 77, three years lower than the OECD average of 80.4. Japan has the highest at 84.73(3). My goal is to move us to the top of that list where we belong.

For forty-two years, I have practiced full time and volunteered for multiple health care organizations both locally and nationally. The organizational top positions that I have held include President of the New Jersey Podiatric Medical Society, President of the American Podiatric Medical Association, President of Medical Staff at Newton Medical Center, Chairman of the Podiatry Section of the National Academies of Practice, Chairman of the Surgery Department at Newton Medical Center, Chairman of the Podiatry Section of the American Public Health Association and Treasurer of Karen Ann Quinlan Hospice.

As a result, I have experienced many shortcomings in health care. This gives me a first-hand view into the system that has failed us. It’s impossible to improve anything when you do not have a full understanding of the issue. The perspective that I am sharing with you is mine based on over four decades of providing podiatric care to my community and volunteering for multiple health care associations.

I will discuss how we got into this situation and a few potential solutions for getting out of it. To find the best solutions that will make us the leader of health care in the world, the entire delivery of health care must be evaluated at the same time and everyone that has anything to do with the health care system must be involved. That would include: all national associations of those who provide health care in any manner, America’s Health Insurance Plans, National Pharmaceutical Association, American Institute for Medical and Biological Engineering and patient advocate groups. Unless everyone is at the table and understands each other’s issues, a long-lasting solution will not be possible. This is a commonsense beginning but has never been done. The goal of the group must be to provide the best quality care to the citizens of the United States of America. Many of the answers are nothing more than simple solutions with the application of common sense.

The subsequent podcasts will talk about various health care system delivery inadequacies that were highlighted in the Commonwealth Fund Report. The issues are all multifaceted involving not only the delivery of the care itself but also peripheral issues that affect the care such as access to care and transportation. Health care system payment concerns and administrative burdens will be addressed. There are other bottlenecks within the health care system that will also be deliberated.

If you want a better health care system and think that what I’m proposing will get our country there, then contact the organizations that I will mention and request that they send a representative to the Zoom meetings to start on February 5, 2025, at 4:00 pm EST. They have all been sent an invitation for the proposed collaboration on health care. I will provide the names and phone numbers of the various organizations at the end, but you can see all the organizations and their phone numbers on the website: www.betterhealthcarereform.com. It is appropriate if no one answers the phone to leave a voicemail. A simple statement such as please participate in Let’s Fix It health care reform Zoom meetings starting February 5, 2025, at 4:00 pm EST. Feel free to give your name and any other pertinent information you are comfortable sharing. The listed associations received a letter in December with all the details.

Those who attend will rewrite the health care proposition that will be sent to Congress to make the appropriate changes whether it is a law or alterations in the delivery of health care. A summary of each meeting will be posted on the website within a few days so you can keep up with the progress and provide feedback. Likewise, the recommended changes that will be sent to Congress for approval will be posted.

The Affordable Care Act took 26 months from the time President Obama took office until it was passed by Congress on March 23, 2010. It was not implemented until January 1, 2014, 45 months later. Our goal is to write the proposal, pass Congress and be implemented in less than six years.

The following are the names and phone numbers of the organizations that need to be contacted to participate in the Let’s Fix It Zoom meetings for health care reform.

American Academy of Physician Assistants: (703) 836-2272

American Association for Respiratory Care: (972) 243-2272

American Association of Nurse Anesthesiology: (847) 692-7050

American Association of Nurse Practitioners: (512) 442-4262

American Chiropractic Association: (703) 276-8800

American Dental Association: (312) 440-2500

American Health Care Association/National Center for Assisted Living: (202) 842-4444

American Hospital Association: (202) 638-1100

American Institute for Medical and Biological Engineering: (202) 496-9660

American Medical Association: (312) 262-3211

American Nurses Association: (800) 284-2378

American Occupational Therapy Association: (301) 652-6611

American Osteopathic Association: (312) 202-8000

American Physical Therapy Association: (800) 999-2782

American Podiatric Medical Association: (301) 581-9200

American Public Health Association: (202) 777-2742

America’s Health Insurance Plans: (202)778-3200

National Association for Home Care and Hospice: (202) 547-7424

National Patient Advocate Foundation: (202) 347-8009

National Pharmaceutical Association: (480) 405-9291

Thank you for taking time out of your day to listen to this podcast. Please share this with your family and friends and let’s work toward a better health care system for all American citizens. Please contact the organizations and let them know that you would appreciate their participation at the Let’s Fix It meetings so we can achieve a better quality of health care for all Americans and reverse our rank in health care in the world.

(1)Roosa Tikkanen and Melinda K. Abrams, U.S. Health care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? (Commonwealth Fund, Jan.2020).

(2)Cha, A. and Cohen, R. A., “Demographic Variation in Health Insurance Coverage: United States, 2021, National Health Statistics Report, no. 177 (Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Nov. 3, 2022).

(3)Gunja, M., Gumas, E. & Williams II, R. (2023), U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. Global Perspective on U.S. Health Care | Commonwealth Fund.